metformin and repaglinide

What is the most important information I should know about metformin and repaglinide?

You should not use this medication if you are allergic to metformin (Glucophage) or repaglinide (Prandin), if you have kidney disease or type 1 diabetes, or if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

You should not use metformin and repaglinide together with gemfibrozil (Lopid) or NPH insulin (such as isophane insulin).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and repaglinide.

Some people develop lactic acidosis while taking metformin. Early symptoms may get worse over time and this condition can be fatal. Get emergency medical help if you have even mild symptoms such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

Take care not to let your blood sugar get too low. Low blood sugar (hypoglycemia) can occur if you skip a meal, exercise too long, drink alcohol, or are under stress. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, or trouble concentrating. Carry hard candy or glucose tablets with you in case you have low blood sugar. Other sugar sources include orange juice and milk. Be sure your family and close friends know how to help you in an emergency.

What is metformin and repaglinide?

Metformin and repaglinide are oral diabetes medications that help control blood sugar levels. Repaglinide works by causing the pancreas to produce insulin. Metformin works by decreasing glucose (sugar) production in the liver and decreasing absorption of glucose by the intestines.

The combination of metformin and repaglinide is used together with diet and exercise to treat type 2 diabetes.

Metformin and repaglinide may also be used for other purposes not listed in this medication guide.

What should I discuss with my doctor before taking metformin and repaglinide?

Some people develop a life-threatening condition called lactic acidosis while taking metformin. You may be more likely to develop lactic acidosis if you have liver or kidney disease, congestive heart failure, a severe infection, if you are dehydrated, or if you drink large amounts of alcohol. Talk with your doctor about your individual risk.

You should not use this medication if you are allergic to metformin (Glucophage) or repaglinide (Prandin), or if you have:

type 1 diabetes;

kidney disease;

if you also use gemfibrozil (Lopid) or NPH insulin (such as isophane insulin); or

if you are in a state of diabetic ketoacidosis (call your doctor for treatment with insulin).

If you need to have any type of x-ray or CT scan using a dye that is injected into your veins, you will need to temporarily stop taking metformin and repaglinide.

To make sure you can safely take this medication, tell your doctor if you have any of these other conditions:

liver disease; or

a history of heart disease.

FDA pregnancy category C. It is not known whether metformin and repaglinide will harm an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medication..

It is not known whether metformin and repaglinide passes into breast milk or if it could harm a nursing baby. You should not breast-feed while using metformin and repaglinide.

How should I take metformin and repaglinide?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results.

Metformin and repaglinide is usually taken 2 or 3 times daily, within 15 minutes before eating a meal. Follow your doctor's instructions. If you skip a meal, do not take your dose of metformin and repaglinide. Wait until your next meal.

Your blood sugar will need to be checked often, and you may need other blood tests at your doctor's office. Visit your doctor regularly.

Always keep a source of sugar available in case you have symptoms of low blood sugar. Sugar sources include orange juice, glucose gel, candy, or milk. If you have severe hypoglycemia and cannot eat or drink, use an injection of glucagon. Your doctor can give you a prescription for a glucagon emergency injection kit and tell you how to give the injection.

Check your blood sugar carefully during a time of stress or illness, if you travel, exercise more than usual, drink alcohol, or skip meals. These things can affect your glucose levels and your dose needs may also change.

Your doctor may want you to stop taking this medication for a short time if you become ill, have a fever or infection, or if you have surgery or a medical emergency. Ask your doctor how to adjust your dose if needed. Do not change your medication dose or schedule without your doctor's advice.

Your doctor may have you take extra vitamin B12 while you are taking metformin and repaglinide. Take only the amount of vitamin B12 that your doctor has prescribed.

Store at room temperature away from moisture, heat, and light.

What happens if I miss a dose?

Take the missed dose as soon as you remember, but only if you are getting ready to eat a meal. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

Overdose may also cause a life-threatening condition called lactic acidosis. Get emergency medical help if you have any of these symptoms of lactic acidosis: weakness, increasing sleepiness, slow heart rate, cold feeling, muscle pain, shortness of breath, stomach pain, feeling light-headed, and fainting.

What should I avoid while taking metformin and repaglinide?

Avoid drinking alcohol. It lowers blood sugar and may increase your risk of lactic acidosis while taking metformin and repaglinide.

What are the possible side effects of metformin and repaglinide?

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Hypoglycemia, or low blood sugar, is the most common side effect of metformin and repaglinide. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar.

This medication may cause lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get emergency medical help if you have even mild symptoms of lactic acidosis, such as: muscle pain or weakness, numb or cold feeling in your arms and legs, trouble breathing, stomach pain, nausea with vomiting, slow or uneven heart rate, dizziness, or feeling very weak or tired.

Less serious side effects may include:

headache;

nausea, diarrhea; or

runny or stuffy nose, sneezing, cough, or cold symptoms.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect metformin and repaglinide?

Using beta-blockers such as atenolol (Tenormin), carvedilol (Coreg), metoprolol (Lopressor, Toprol), and propranolol (Inderal, InnoPran) can make it harder for you to tell when you have low blood sugar. Tell your doctor if you use any heart or blood pressure medication.

other diabetes medications such as pioglitazone (Actos, Duetact, Actoplus Met) or tolbutamide (Orinase); or

a sulfa drug, such as sulfisoxazole (Pediazole, and others) or trimethoprim (Bactrim, Primsol, Proloprim, Septra, Cotrim).

This list is not complete and other drugs may interact with metformin and repaglinide. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

Your pharmacist can provide more information about metformin and repaglinide.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

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